The objective of this study was to investigate differences in self-perceived and dentist-determined treatment need in Australian-born and migrant residents of Australia. Participants in the National Survey of Adult Oral Health 2004-06 were categorized into six groups according to country of birth. Interview and examination data were used to analyze differences between self-perceived and the 'gold standard' examiner-determined treatment need, and to compare the accuracy of self-reporting according to country of birth. Self-reported treatment needs, defined as the need for a restoration and/or extraction, were cross-tabulated with clinically observed conditions and compared using a multivariable logistic regression model. Concordance between self-reported and clinically-determined treatment need differed significantly for migrants from Europe and the UK and Australian-born individuals. In the logistic regression model, stratification according to examiner-determined treatment need revealed significantly greater reporting of treatment need by Asian-born migrants than by the Australian-born reference group. The results of this study demonstrate that self-perceived treatment need was less than the examiner-determined findings in European and UK migrant groups and Australian-born individuals. Additionally, Asian migrants were more likely than Australian-born individuals to over-report treatment need for a filling and/or extraction.